RESUMEN
INTRODUCTION AND IMPORTANCE: Thumb carpometacarpal (CMC) joint arthritis is the most common condition in older adults and an upper-extremity surgical reconstruction site. Multiple treatments for CMC arthritis have been developed. Among them, suspension sling arthroplasty provides great results without requiring a tendon graft or advanced implants. However, it is rarely used in Indonesia. CASE PRESENTATION: The modified suture suspension sling arthroplasty technique developed by Arnold Peter C Weiss was performed on three patients with CMC joint arthritis. In this procedure, after trapeziectomy, a nonabsorbable suture is performed to create a hammock between the abductor pollicis longus and flexor carpi radialis tendon to rest the thumb base metacarpal. The rehabilitation protocol was then continued, and the postoperative clinical condition was observed. Three weeks postoperatively, none of the three patients complained of pain. At 3 months postoperatively, there were no signs of infection, and all patients continued the rehabilitation protocol. At 6 months postoperatively, thumb range of motion was excellent, with no sign of infection and an increased DASH score of <5. CLINICAL DISCUSSION: Multiple treatments for CMC joint arthritis have been described in the literature but the indications and which treatment provides the best results were unclear. Among the various suspension sling methods, trapeziectomy is important for treating CMC joint arthritis. CONCLUSION: Suture suspension arthroplasty for treating thumb CMC joint arthritis achieved excellent clinical results and has several advantages, including shorter surgical time, no additional incision, reduced cost, no tendon harvesting, and implant fixation.
RESUMEN
INTRODUCTION AND IMPORTANCE: Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, a mixture of benign cartilage and fibrous and myxoid tissue. It usually affects young people, commonly in the second and third decades of life with male being predominant. Differential diagnosess in chondromyxoid fibroma, are giant cell tumor, bone cyst, enchondroma, osteoblastoma, and low-grade chondrosarcoma. CASE PRESENTATION: We present a case of an 18-years-old male, with chief complaint of pain on the right knee since 3 year ago with an increasing size reaching diameter of 55 cm within three years. The radiograph and MRI revealed lytic blastic expansile multiloculated lesion, with wide transitional zone, and periosteal reaction on the epymetadiaphyseal part of right proximal tibia. The surgical procedure was performed consist of wide excision, reconstruction by cement knee arthrodesis using Kuntscher-nail, dynamic compression plate, bone cement and gastrocnemius flap. CLINICAL DISCUSSION: After 3 months of surgery follow-up, there was no sign of recurrence, the patient walked partially weight bearing with a crutch. In 1 years post operative follow up, the Muscukoskeletal Tumor Society Scoring (MSTS) was 80%. There was no sign of recurrence. CONCLUSION: In cases with large tumor size, wide excision with bone and soft tissue reconstructive surgery is required as mechanical and biological reconstruction. The cement arthrodesis provides a faster duration of surgery, lower risk of infection, and good functional outcome.
